The National Institute for Health and Clinical Excellence (NICE) recommends a range of psychological therapies to treat people with depression and anxiety disorders and bring them to recovery. It also recommends these therapies are used to provide a system of stepped care, shown in the diagram below. Stepped care has two principles:
- treatment should always have the best chance of delivering positive outcomes while burdening the patient as little as possible, and
- a system of scheduled review to detect and act on non-improvement must be in place to enable stepping up to more intensive treatments, stepping down where a less intensive treatment becomes appropriate and stepping out when an alternative treatment or no treatment become appropriate.
For diagrams showing the recommended stepped care pathway in IAPT services, and a table of NICE indicated treatments for Depression, see pages 15 and page 16 of the Guidance for Commissioning IAPT Training 2011/12 -2014/15
Staffing of NHS IAPT Services
Two types of psychological therapy practitioners are trained to deliver therapies in NHS IAPT services:
- High Intensity therapists trained in cognitive behavioural therapy for people with moderate and severe depression and anxiety disorders, and a range of other therapies as recommended by NICE
- Psychological wellbeing practitioners trained in cognitive behavioral approaches for people with mild to moderate anxiety and depression. These approaches include guided self help and delivering psycho-educational groups. Services will also have administrative staff, employment advisors, a GP advisor and links with other services such as housing, drugs advice and benefits
Refer to the Workforce section on this site for further information and guidance regarding the training and development of an IAPT workforce.
It is important that people have a say in what kind of treatment they receive. This helps ensure the best health outcome for them. Clinicians should explain which treatment they are recommending and why they think it is suitable for the patient. A booklet has been produced, called the `Which Talking Therapy for Depression`, to help guide patients and staff through the therapy options that are typically available in an NHS IAPT service.
Some people will refer themselves to the service but most will be referred for therapy by their GP or a member of the practice team. The team and their patients should have clear information about local services and the treatment choices available.
IAPT services routinely measure people's health outcome. This charts their progress and has therapeutic benefit. It is part of ongoing, collaborative service evaluation too, providing feedback on elements of treatment that are helpful or unhelpful. For further detailed information about patient outcome measures and their routine collection in NHS IAPT services see the IAPT Data Handbook available on the Measuring Outcomes page.